Inflammation markers and peripheral arterial disease severity: The elephant in the room

Abstract

Dear Editor,

We have read the article by Oflar et al. 1 entitled “Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease” with great interest. First of all, we congratulate the authors for their valuable contribution to the literature. However, we would like to discuss some issues about the severity and complexity of lower extremity arterial disease (LEAD) and its relationships between inflammatory markers.

The authors included patients diagnosed with LEAD between January 2019 and December 2022 in the current study. The relationship between LEAD complexity according to the Trans-Atlantic Inter-Society Consensus-II (TASC II) classification and systemic immune-inflammation index (SII) value was investigated. The authors concluded that a high SII value might indicate the complexity of LEAD.¹ First of all, the study was conducted during the years when the coronavirus disease 2019 (COVID-19) pandemic was intense. Were patients with COVID-19 infection included in the study? If included, was there any difference between the two groups? The relationship between atherosclerosis and COVID-19 has become a highly debated issue today.^2,3 A study has shown that COVID-19 disease may play a role in the pathogenesis of peripheral artery disease.⁴

TASC II classification is an important angiographic classification indicating the severity of LEAD. This classification is very important in determining the revascularization methods of patients. TASC II classification can be made as aortoiliac, femoropopliteal, and below the knee.⁵ In the current study, the relationship between the SII value and the severity of atherosclerosis was investigated. Accordingly, patients were divided into two groups: TASC A-B and TASC C-D. According to which anatomical region was the TASC II classification made? How was the evaluation made for LEAD in more than one region?

Finally, diabetes mellitus (DM) and blood lipids are very important in the development and prognosis of atherosclerotic cardiovascular diseases.^6,7 In the current study, the frequency of DM (p = .792) and blood lipid values were found to be similar between the groups. We are curious about the authors’ valuable comments on this situation. For example, in terms of DM, could the severity of diabetes have caused this situation?

Footnotes

Authors’ note

All authors substantially contributed to (1) conception and design, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Mesut Engin

References

Oflar

Akdeniz

Yıldız

, et al. Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease. Vascular 2024; 17085381241251772. DOI:10.1177/17085381241251772.

Ciumanghel

Buzincu

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, et al. Epidemiology, clinical features and prognostic factors in patients with Covid-19 and acute limb ischaemia - a single center study. Vascular 2024; 17085381241236932. DOI:10.1177/17085381241236932.

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, et al. COVID-19 related peripheral arterial thrombotic events in intensive care unit and non-intensive care unit patients: a retrospective case series. Vascular 2024; 32: 366–373. DOI: 10.1177/17085381221140159.

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, et al. Role of SARS-COV-2 and ACE2 in the pathophysiology of peripheral vascular diseases. Biomed Pharmacother 2023; 166: 115321.

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, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society Consensus for the management of peripheral arterial disease (TASC II). J Endovasc Ther 2015; 22(5): 663–677.

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